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Alvarez Rio A, Roca Mas JO, Soroa Moreno GJ, Navarro Sanchez D, Monge Castresana I, Estrada Cuxart J. Reconstruction Using Perforator Propeller Flaps After Malignant Melanoma Resection of the Lower Extremity. Plast Surg (Oakv) 2024; 32:276-282. [PMID: 38681257 PMCID: PMC11046280 DOI: 10.1177/22925503221116279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 05/01/2024] Open
Abstract
Introduction: Surgical excision with margin of 2 cm is the treatment of choice in malignant cutaneous melanoma when Breslow index is >1 mm. When located on the lower limb, these resections can lead to large defects that require complex reconstruction in order to salvage the limb. The use of propeller-perforator flaps has multiple advantages such as the preservation of adjacent muscles, decrease in morbidity in the donor site, and good aesthetic and functional results. Our objective is to expose our experience and results with the use of propeller-perforator flaps for coverage of this kind of defects. Materials and Methods: Patients with malignant cutaneous melanoma of the lower limb who required reconstruction with a propeller-perforator flap between the years 2015 and 2021 in our plastic surgery department were included in this retrospective research. Demographic, reconstructive, oncologic, and functional data were collected and analyzed. Results: The cohort of 22 patients showed 100% of successful reconstructive outcomes. Only 2 patients experienced distal necrosis of the flap that was resolved with local dressings. Fast recovery and early capacity to walk were achieved in the majority of the patients with an average of 10.1 days until weight-baring walking. The 2-year overall and progression-free survival rates were 86.37% and 81.82%, respectively. Conclusion: The use of propeller perforator flaps for oncological defects coverage in the lower limb location has to be considered as a reliable choice as it takes less surgical time and a faster recovery. It allows limb salvage with an adequate length and functionality, with minimal donor site morbidity and a lower index of complications, contributing to improve patient's quality of life and not delaying other oncological treatments.
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Affiliation(s)
- Adela Alvarez Rio
- Plastic and Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Josep Oriol Roca Mas
- Plastic and Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Daniel Navarro Sanchez
- Plastic and Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Ivan Monge Castresana
- Plastic and Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jaime Estrada Cuxart
- Plastic and Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Ota M, Motomiya M, Watanabe N, Shimoda K, Iwasaki N. Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study. BMC Musculoskelet Disord 2024; 25:297. [PMID: 38627691 PMCID: PMC11020679 DOI: 10.1186/s12891-024-07433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. METHODS We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. RESULTS The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. CONCLUSIONS Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. DATA ACCESS STATEMENT The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan.
| | - Naoya Watanabe
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
| | - Kohei Shimoda
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Nishi 14 Minami 10, Obihiro, 080-0024, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ismail S, Zulfiqar B, Sami W, Gulzar S, Akhlaq F, Naz E, Rupani S. Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps. Cureus 2024; 16:e51755. [PMID: 38318547 PMCID: PMC10842339 DOI: 10.7759/cureus.51755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard. METHODOLOGY It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively. CONCLUSION Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.
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Affiliation(s)
- Sarosh Ismail
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Bushra Zulfiqar
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Waqas Sami
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sadaf Gulzar
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Faisal Akhlaq
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Erum Naz
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sukaina Rupani
- Department of General Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
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Can B, Koçman AE. Perforator-Based V–Y Advancement Medial Thigh Flap for Scrotal and Perineal Reconstruction after Fournier Gangrene. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03195-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abdel Fattah HAH, El-Mahy MM, Atiyya AN, Diab RA, Aly AM. Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:375-381. [PMID: 32895737 DOI: 10.1007/s00590-020-02780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. METHODS Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20 cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. RESULTS Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5 cm to 4.5 × 10.5 cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. CONCLUSION Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.
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Affiliation(s)
| | - Mohammed Mostafa El-Mahy
- Hand and Microsurgery Unit, Orthopaediic Department, Ain Shams University Hospital, Cairo, Egypt
| | - Ahmed Naeem Atiyya
- Hand and Microsurgery Unit, Orthopaediic Department, Ain Shams University Hospital, Cairo, Egypt
| | - Ramy Ahmed Diab
- Hand and Microsurgery Unit, Orthopaediic Department, Ain Shams University Hospital, Cairo, Egypt
| | - Amr Mohamed Aly
- Hand and Microsurgery Unit, Orthopaediic Department, Ain Shams University Hospital, Cairo, Egypt.
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Abstract
Microsurgical tissue transfer may provide reconstructive option for extensive loss of tissues due to upper extremity trauma or tumor resection. This article reviews the authors' experience in using microsurgical tissue transfers for reconstruction of upper extremity trauma.
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Affiliation(s)
- Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China; Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
| | - Li Wen Hao
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
| | - Lin Feng Liu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, Shandong, China
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Soteropulos CE, Shulzhenko NO, Nayar HS, Poore SO. The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review. J Reconstr Microsurg 2020; 36:634-644. [DOI: 10.1055/s-0040-1713598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeletonization on perforator-based fasciocutaneous flaps of the lower extremity.
Methods PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were reviewed for literature examining perforator-based fasciocutaneous flaps from knee to ankle, from January 2000 through November 2018. The Preferred Reporting Items for Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used.
Results Thirty-six articles were included for quantitative analysis. Of 586 flaps, 365 were skeletonized (60.1%) with 58 major (9.9%) and 19 minor complications (3.2%). With skeletonization, overall reoperative rate was higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) and rotational flaps (OR: 18.87, p = 0.004). The complication rate of rotational flaps also increased (OR: 2.60, p = 0.04). Notably, skeletonization reduced complications in flaps rotated 90 degrees or more (OR: 0.21, p = 0.02). Reoperative rate of distal third defects (OR: 14.08, p = 0.02), flaps over 48 cm2 (OR: 33.33, p = 0.01), and length to width ratios over 1.75 (OR: 7.52, p = 0.03) was increased with skeletonization. Skeletonization increased complications in traumatic defects (OR: 2.87, p = 0.04) and reduced complications in malignant defects (OR: 0.10, p = 0.01).
Conclusion Pedicled, perforator-based flaps can provide a reliable locoregional alternative to free tissue transfer for lower extremity defects. Though skeletonization increased the overall reoperative rate, the complication rate for flaps with 90 degrees or more of rotation was significantly reduced. This suggests skeletonization should be considered when large rotational movements are anticipated to reduce complications that can arise from pedicle compression and venous congestion.
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Affiliation(s)
- Carol E. Soteropulos
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nikita O. Shulzhenko
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Harry S. Nayar
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel O. Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model. Arch Plast Surg 2020; 47:209-216. [PMID: 32453928 PMCID: PMC7264910 DOI: 10.5999/aps.2019.00871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival. Methods In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap). Results Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1. Conclusions Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model.
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Lese I, Grobbelaar AO, Sabau D, Georgescu AV, Constantinescu MA, Olariu R. The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations. J Bone Joint Surg Am 2020; 102:510-518. [PMID: 31804239 DOI: 10.2106/jbjs.19.00648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. METHODS All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. RESULTS Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). CONCLUSIONS Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ioana Lese
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Adriaan O Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dan Sabau
- Department III, Surgical Clinic, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Alexandru V Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, and Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Recovery, University of Medicine Iuliu Hatieganu, Cluj Napoca, Romania
| | - Mihai A Constantinescu
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Chan JKK, Ferguson JY, Scarborough M, McNally MA, Ramsden AJ. Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art. Indian J Plast Surg 2019; 52:62-72. [PMID: 31456614 PMCID: PMC6664835 DOI: 10.1055/s-0039-1687920] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Osteomyelitis (OM) of the lower limb represents a large unmet global healthcare burden. It often arises from a contiguous focus of infection and is a recognized complication of open fractures or their surgical treatment, arthroplasty, and diabetic foot ulcers. Historically, this debilitating condition is associated with high rates of recurrence and secondary amputation. However, excellent long-term outcomes are now achieved by adopting a multidisciplinary approach with meticulous surgical debridement, skeletal and soft tissue reconstruction, and tailored antimicrobial treatment. This review focuses on the modern evidence-based management of post-traumatic OM in the lower limb from a reconstructive plastic surgery perspective, highlighting the latest developments and areas of controversy.
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Affiliation(s)
- James K K Chan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.,Bone Infection Unit, Oxford University Hospitals, United Kingdom
| | - Jamie Y Ferguson
- Bone Infection Unit, Oxford University Hospitals, United Kingdom
| | | | - Martin A McNally
- Bone Infection Unit, Oxford University Hospitals, United Kingdom
| | - Alex J Ramsden
- Bone Infection Unit, Oxford University Hospitals, United Kingdom
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Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: A comparison✰. J Plast Reconstr Aesthet Surg 2019; 72:181-187. [DOI: 10.1016/j.bjps.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/16/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
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Cerny M, Harder Y, Zimmermann A, Eckstein HH, Machens HG, Schantz JT, Schenck TL. [Locoregional solutions for groin defects : Coverage after vascular surgery]. Chirurg 2016; 88:43-49. [PMID: 27435247 DOI: 10.1007/s00104-016-0244-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vascular surgery through a groin incision may be associated with severe wound healing disorders in this sensitive area. There are many options to reconstruct the defect surgically. The choice of surgical reconstruction depends mainly on the individual status of vasculature, which is most often compromised in these patients. There are random pattern flaps, as well as perforator, pedicled flaps or microvascular flaps to choose from. AIM We give an overview of plastic surgical solutions for groin defects, with a special focus on complex wounds after vascular surgical complications. We discuss advantages and disadvantages of different flaps with two case reports and also show alternatives. PATIENTS AND METHODS We demonstrate in two cases how the reconstruction of the groin defect was planned, taking into account the vascular status, and why we chose an innovative and seldom-used option in each case. RESULTS The selected flaps, a pedicled fasciocutaneous ALT propeller flap and a perforator-based, pedicled abdominal advancement flap reconstructed the defects successfully. DISCUSSION The surgical therapy for the reconstruction of groin defects should be chosen according to the individual vascular status to ensure safe and reliable blood supply. To guarantee the best possible reconstruction and avoid postoperative healing disorders and infections, less common flaps should also be considered.
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Affiliation(s)
- M Cerny
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Y Harder
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano, Sede Italiano (OIL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz
| | - A Zimmermann
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - H-H Eckstein
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - H-G Machens
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - J-T Schantz
- Klinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - T L Schenck
- Abteilung für Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, Ludwig-Maximilians-Universität München, München, Deutschland
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